anodyne paper

1. ROLE OF ANODYNE THERAPY
MONOCHROMATIC INFRARED PHOTOENERGY IN
DIABETIC PERIPHERAL NEUROPATHY
DR GHANSHYAM GOYAL, DR A K JAIN, DR REKHA SRIVASTAVA
S.K.DIABETES RESEARCH AND EDUCATION CENTRE
118, R.R.Sarani, Kolkata -9
skdiab@yahoo.co.in

2.  Distal polyneuropathy is the most common
complication affecting the lower extremities of
patients with dm
 Upto 60% of patients with long standing dm, had
dpn
 Neuropathy, a major etiological component of
diabetic foot ulcer
 Is present in more than 82% of diabetics with foot
wounds
 Is a leading cause of amputations and high
mortality rates among diabetics.

3. SYMPTOMS
 Burning
 Tingling
 Stabbing & pins & needles sensation in a
stocking & gloves distribution
 Patient may often display muscle weakness,
incoordination and ataxia

4. The association between
neuropathic pain and decreased
quality of life in patients with
DPN is well documented.

5. PATHOGENISIS OF DPN
 Poorly understood
 Multifactorial
 Hyperglycemia - being the prime risk
factor
 Ischaemic

6. THEORIES
 Abnormalities of protien glycation
 Sorbitol accumalation
 Polyol pathway flux
 Protein kinase activation
 Advanced glycation end product
 Decrease in neuronal nitric oxide synthaetase
protein
 Microvascular hypoxia

7. One of the causative factors is
decreased endoneural blood flow

8. MANAGEMENT OF DN
 Disease modification
 Symptomatic treatment
 DISEASE MODIFICATION
 Glycaemic control
 Association of vascular risk factors with DN
 Aldolase reductase inhibitors(ARIS)
 Alpha Lipoic acid
 Carnitine
 Neurotrophic therapy

9. SYMPTOMATIC TREATMENT
 Tricyclic Antidepressants
 Anticonvulsants ( Phenytoin,
Carbomazepine & Gabapentin)
 Tramadol
 Analgesics are not of much benefit and
narcotic should be avoided because of
addiction potential.
 TNS
 ANODYNE THERAPY

10. MIRE TECHNOLOGY
The anodyne therapy system delivers mire through therapy
arrays, each containing 60 super-luminous diodes ( 890
nanometers, near infrared wavelength). These diodes are
attached to a control unit that pulses the mire at 292
times/sec. The therapy arrays are placed in direct contact
with the skin to temporarily increase local micro-
circulation.

11. ANODYNE THERAPY

12. BASELINE CHARACTERISTIC OF PATIENTS
 No of patients in study = 47
 Mean age = 57.91 ( 38-81 yrs)
 Mean duration of diabetes = 12.7 yrs
 Mean biothesiometer
Right - 35.6 v
Left - 35.8 v
 Male : female 33: 14

13. VPT – PRE ANODYNE THERAPY
Right Foot Left Foot
PRE PRE
GT 36.48 36.6
1ST
MT 34.78 36.70
3RD
MT 36.30 35.72
5TH
MT 35.80 35.48
INSTEP 33.50 35.10
HEEL 35.80 34.38

14. VPT – RIGHT FOOT
RIGHT FOOT
PRE POST P VALUE
GT 36.48 23.50
1ST
MT 34.78 22.76
3RD
MT 36.30 22.90
5TH
MT 35.80 21.80
INSTEP 33.50 22.40
HEEL 35.80 23.59
Significant

15. VPT – LEFT FOOT
LEFT FOOT
PRE POST P VALUE
GT 36.6 21.8
1ST
MT 36.70 23.87
3RD
MT 35.72 24.4
5TH
MT 35.48 24.0
INSTEP 35.10 22.0
HEEL 34.38 23.8
Significant

16. PATIENT SYMPTOMS SCORE
N = 47 Marked
improvement
Improvement Mild
improvement
Pain 26 07 14
Sensation 14 23 08
Numbness,
tingling &
parasthesias
21 20 06
Balance 04 18 04
Fall 02 - -

17. CONCLUSION
 Our knowledge regarding the pathogenisis
of DN has grown significantly in last two
decades
 But identifying effective treatment regime
remains a challenge

18.  Prevention remains the foundation of clinical
intervention and the pre requisites of
adequate treatment
 Mire treatments are associated with increased
foot sensation in patients with dpn

19. IMPROVED FOOT SENSITIVITY BASED ON
THE USE OF MIRE MIGHT BE ASSOCIATED
WITH A REDUCED INCIDENCE OF
DIABETIC FOOT WOUNDS AND
AMPUTATIONS

20. EVIDENCE CONCERNING THE USE OF MIREEVIDENCE CONCERNING THE USE OF MIRE
FOR DPNFOR DPN
JOURNAL REF n Study TypeJOURNAL REF n Study Type EndpointsEndpoints
JJ AmerAmer Pod Med Assn (13) 49Pod Med Assn (13) 49 Prospective,,openProspective,,open labellabel QuantitativemonofilamentsQuantitativemonofilaments
Hot/Cold DiscriminationHot/Cold Discrimination
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Endocrine Practice (12) 27Endocrine Practice (12) 27 Prospective,,openProspective,,open label Pretreatment control grouplabel Pretreatment control group
Neurometer,CPT/sNCTNeurometer,CPT/sNCT
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Diabetes Care (11) 27Diabetes Care (11) 27 Randomized,doubleRandomized,double SWM; VAS Pain; MNSI;SWM; VAS Pain; MNSI;
blind,placeboblind,placebo controlledcontrolled BalanceBalance
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
J of Geriatric physical (14) 38J of Geriatric physical (14) 38 Prospective,,openProspective,,open label SWM;label SWM; TinettiTinetti Gait andGait and
TherapyTherapy Balance; Actual FallsBalance; Actual Falls
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Advances in Skin and (15) 8Advances in Skin and (15) 8 Retropective,questionnaireRetropective,questionnaire Incidence of new woundsIncidence of new wounds
Wound careWound care time of healingtime of healing
JJ AmerAmer Pod Med Assn (15) 1047 Prospective, chart review SWMPod Med Assn (15) 1047 Prospective, chart review SWM